SARS-CoV-2 infection complicated by intrahepatic cholestasis of pregnancy

2021 ◽  
Vol 29 (11) ◽  
pp. 654-657
Author(s):  
Irshad Ahmed ◽  
Mustafa Elgasim ◽  
Anoop Rehal ◽  
Bee K Tan
Keyword(s):  
Bile Acid ◽  
Ursodeoxycholic Acid ◽  
Pregnancy Outcomes ◽  
Intrahepatic Cholestasis ◽  
Clinical Case ◽  
Adverse Pregnancy Outcomes ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Secondary Bile Acid ◽  
Adverse Pregnancy ◽  
Cholestasis Of Pregnancy

This article reports a case of SARS-CoV-2 infection complicated by intrahepatic cholestasis of pregnancy in the second trimester in a South Asian woman. She presented with itchiness and grossly elevated bile acid following SARS-CoV-2 virus infection. Her cholestasis resolved in parallel with her infection while she was being treated with ursodeoxycholic acid. Bile acid is considered harmful to a developing fetus and is associated with adverse pregnancy outcomes, particularly stillbirth. Ursodeoxycholic acid is still commonly used in the treatment of these patients despite controversy about its value. It has anti-inflammatory properties and there have been suggestions that this could benefit patients with SARS-CoV-2. Elevated levels of primary bile acids (cholic and chenodeoxycholic acid) are considered harmful to a developing fetus, and are associated with adverse pregnancy outcomes, in particular, stillbirth. The secondary bile acid, ursodeoxycholic acid, is thought to be beneficial by reducing cholesterol production in the liver. This clinical case study highlights a diagnostic enigma in the management of this unique clinical case presentation.

Can routine laboratory parameters predict adverse pregnancy outcomes in intrahepatic cholestasis of pregnancy?

2015 ◽  
Vol 43 (6) ◽  
Author(s):  
Efser Oztas ◽  
Kudret Erkenekli ◽  
Sibel Ozler ◽  
Ali Ozgur Ersoy ◽  
Mevlut Kurt ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Preterm Delivery ◽  
Pregnancy Outcomes ◽  
Intrahepatic Cholestasis ◽  
Total Bilirubin ◽  
Adverse Pregnancy Outcomes ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Apgar Scores ◽  
Adverse Pregnancy ◽  
Cholestasis Of Pregnancy

AbstractOur aim was to investigate whether any hematological changes readily detectable by simple complete blood count (CBC), as well as fasting and postprandial total serum bile acid (SBA) levels, have diagnostic values for the prediction of adverse pregnancy outcomes in intrahepatic cholestasis of pregnancy (ICP).A prospective, case control study was carried out including 217 pregnant women (117 women with ICP and 100 healthy controls). The main outcome measures investigated were preterm delivery, APGAR scores, and neonatal unit admission. A multivariate logistic regression model was used to identify the independent risk factors of adverse pregnancy outcomes.Compared with controls, women with ICP had significantly higher mean platelet volume (MPV) (mean 10.2±1.0 vs. 11.0±1.3; P<0.001) and platelet distribution width (PDW) (mean 13.1±2.3 vs. 14.7±2.8; P<0.001) values. Analysis with logistic regression revealed that the probability of preterm delivery did not increase until MPV levels exceeded 11.2 fL [odds ratio (OR)=2.68, 95% confidence interval (CI)=1.13–6.32, P=0.025], and total bilirubin levels exceeded 0.6 mg/dL (OR=3.13, 95% CI=1.21–8.09, P=0.019). Considering the low APGAR scores, only increased postprandial total SBA levels of ≥51 μmol/L were found to be predictive significantly (OR=3.02, 95% CI=1.07–8.53, P=0.037).Our study suggests that increased MPV and total bilirubin levels are associated with preterm delivery, and increased postprandial total SBA levels are predictive for low APGAR in ICP patients.

scholarly journals Intrahepatic cholestasis of pregnancy

2021 ◽  
Vol 16 (S3) ◽  
pp. 50-55
Author(s):  
Ana Maria SCUTELNICU ◽  
◽  
Brînduşa Ana CIMPOCA-RAPTIS ◽  
Anca Marina CIOBANU ◽  
Nicolae GICĂ ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Intrahepatic Cholestasis ◽  
Perinatal Outcomes ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Fetal Asphyxia ◽  
Increased Risk ◽  
Adverse Perinatal Outcomes ◽  
Adverse Pregnancy ◽  
Cholestasis Of Pregnancy ◽  
Meconium Stained Amniotic Fluid

Intrahepatic cholestasis of pregnancy is the most common liver disease during pregnancy. The main features are maternal pruritus, in the absence of a rash, and raised serum bile acids. Intrahepatic cholestasis of pregnancy is associated with an increased risk of adverse perinatal outcomes, including preterm birth, meconium-stained amniotic fluid, fetal asphyxia with neonatal unit admission or even stillbirth. The main treatment option is ursodeoxycholic acid. We review the etiology, diagnosis, adverse pregnancy outcomes, focusing especially on management of this intriguing condition.

360: Intrahepatic cholestasis of pregnancy, outcomes related to bile acid levels

2015 ◽  
Vol 212 (1) ◽  
pp. S189
Author(s):  
Meirav Nezer ◽  
Maayan Bas-Lando ◽  
Rivka Farkash ◽  
Nurit Algor ◽  
Arnon Samueloff ◽  
...  
Keyword(s):  
Bile Acid ◽  
Pregnancy Outcomes ◽  
Intrahepatic Cholestasis ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Cholestasis Of Pregnancy

scholarly journals The Reversed Feto-Maternal Bile Acid Gradient in Intrahepatic Cholestasis of Pregnancy Is Corrected by Ursodeoxycholic Acid

PLoS ONE ◽  
2014 ◽  
Vol 9 (1) ◽  
pp. e83828 ◽  
Author(s):  
Victoria Geenes ◽  
Anita Lövgren-Sandblom ◽  
Lisbet Benthin ◽  
Dominic Lawrance ◽  
Jenny Chambers ◽  
...  
Keyword(s):  
Bile Acid ◽  
Ursodeoxycholic Acid ◽  
Intrahepatic Cholestasis ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Cholestasis Of Pregnancy

scholarly journals Unexplained First Trimester Intrahepatic Cholestasis of Pregnancy: A Case Report and Literature Review

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Anastasia A. Salame ◽  
Mohammad J. Jaffal ◽  
Marco A. Mouanness ◽  
Amal R. Nasser Eddin ◽  
Labib M. Ghulmiyyah
Keyword(s):  
Case Report ◽  
Pregnancy Outcomes ◽  
Intrahepatic Cholestasis ◽  
First Trimester ◽  
Clinical Suspicion ◽  
Total Bile Acid ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Acid Salt ◽  
Adverse Pregnancy ◽  
Cholestasis Of Pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a condition that usually affects the 3rd trimester-pregnant women and is associated with adverse pregnancy outcomes. We present a 31-year-old G2P1 patient with symptoms of ICP as early as 10 weeks of gestation (WG). Her pruritis was initially attributed to eczema. Due to the intensity of her discomfort and failure of topical treatment, ICP was suspected, total bile acid salt levels were taken and ursodeoxycholic acid was subsequently started at 18 WG. The patient was followed closely during her pregnancy to adjust the dose of the medication accordingly. Induction of labor was performed at 37 WG without complications. This case demonstrated the importance of clinical suspicion in the setting of such symptomatology in order not to miss or delay treatment of threatening conditions such as ICP.

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